BACKGROUND: The level of antibiotic resistance of pathogens causing uncomplicated urinary tract infections (UTIs) is increasing. The 2017–2018 GLASS (Global Antimicrobial Resistance and Use Surveillance System) report indicated >70% resistance to ceftriaxone and ciprofloxacin in Escherichia coli in Pakistan.METHODS: A prospective study was conducted in the Médecins Sans Frontières (MSF) supported Timurgara District Hospital, Timurgara, Pakistan, from September 2017 to December 2018. Women aged 18–65 years presenting to the Emergency Department with symptoms of uncomplicated UTI (cystitis/pyelonephritis) were invited to participate. We conducted microbiological culture and sensitivity testing for samples with positive dipstick or nitrite test.RESULTS: Of the 200 patients who participated, 109 (54.5%) were diagnosed with pyelonephritis and 91 (45.5%) with cystitis. Forty-three samples (21.5%) were culture-positive: E. coli was isolated in 27 samples, Enterococcus spp. in 7 and Klebsiella pneumoniae in 6. Overall resistance to ciprofloxacin was observed in 51.8% of E. coli isolates, and ceftriaxone resistance in 66.7% of E. coli isolates and in 33.3% of K. pneumoniae. Resistance to fosfomycin was low (one E. coli isolate).CONCLUSIONS: This study found resistance to first- and second-line antibiotics for treating UTIs as per the MSF protocol. Heightened awareness and potential changes to local prescription practices are necessary to curb the spread of antimicrobial resistance pathogens causing UTIs.

To observe the prevalence of Staphylococcus aureus a total of 1078 blood, pus and miscellaneous samples (sputum, swab and body fluids) were collected among which 478 samples exhibited bacterial growth on agar medium. Out of growth positive 300 pus samples, 116(38.67%) showed the growth of Gram positive cocci, of which 30(25.86%) were Staphylococcus aureus positive. In case of blood, the number of growth positive samples were 116(28.45%), of which 33(12.12%) showed the presence of Gram positive cocci including 4 Staphylococcus aureus. Among the 62 growth positive miscellaneous samples, the number of Gram positive cocci and Staphylococcus aureus positive samples were 22(35.48%) and 4(18.18%), respectively. From the antibiogram of 38 Staphylococcus aureus isolates, 26 were found multidrug resistant, showing resistance against two or more of the antibiotics used namely ampicillin, cefradine, gentamicin and ciprofloxacin, whereas all the isolates were sensitive to vancomycin. The MIC and MBC of these antibiotics against different Staphylococcus aureus isolates were determined, which were found to range from 2µg/ml to 8µg/ml and 4µg/ml to 16µg/ml, respectively, in case of vancomycin. The rate of resistance against ampicillin, cefradine, gentamicin and ciprofloxacin were 92.1%, 60%, 58.1% and 59.35%, respectively.